Statistical data from the NIH states that 18 million U.S. adults suffer from fecal incontinence and are in need of methods to manage bowel function. At the present time there are over 1.3 million persons who are residents in certified nursing facilities in the United States. In addition to those in care centers there are an estimated 500,000 persons in Hospice care. An additional unknown number of persons are bedridden in private residences with private or family member care. The total number of persons requiring fecal incontinent care in the U.S.A. is approximated at well over 2,000,000. Of this population segment, a large percentage are non-ambulatory and bedridden.
When people who have been ambulatory in everyday life are confined to bed, the management of urine and bowel function becomes a major issue. In the 2010 Kaiser Family Foundation report titled, “Total Number of Residents in Certified Nursing Facilities” included a list from Certified Nursing Facilities highlighting the Top Ten Deficiencies. In priority order these were:
1. Quality of Care,
2. Infection Control,
3. Professional Standards, and
4. Dignity.
Kaiser cited privacy, embarrassment, social mores, respect, and self image as contributing factors leading to clinical depression in the bedridden.
There is a need for new art that will deliver improved methods of fecal and urine disposal for the bedridden. Continent people may be able to use a bedpan however; bedpans are very uncomfortable and unsatisfactory for extended use; particularly for the incontinent who are unable to time bowel movements. Frequently these persons are placed in diapers and become subjected to four major problems associated with wearing diapers.                First, diapers trap and mix fecal and urinary discharges against the skin, and genitalia of both male and female persons.        Second, diapers introduce an environment in which it is difficult to maintain clean and healthy skin,        Third, the psychological impact on a person with a sound mind usually result in embarrassment and depression, and        Fourth, the onset of depression requires treatment with anti depressant medications. These medications frequently create constipation resulting in impacted stool for bedridden persons; further complicating and aggravating the care situation.        
Trapping Feces and Urine Against the Skin:
Diapers manage urinary and fecal discharge as a single system. By failing to separate urinary and fecal discharge from contact with the person, diapers enable a toxic mixture of urinary and fecal material to envelop and/or penetrate the genitalia, creating an environment where sanitation concerns are paramount and cleanliness is difficult to achieve. Stated otherwise, trapping fecal and urinary discharges against the skin results in skin irritation and breakdown, which increase the risk of potentially painful or dangerous Incontinence Associated Dermatitis (IAD), urinary infections, chronic disease tissues and ulcers. In females, fecal contamination of the labia, vagina, urethra and/or anus present extremely unhealthy risks leading to frequent urinary tract infections.
Maintaining Clean and Healthy Skin:
Each nursing facility has procedures in place to provide changing of diapers when they become wet or contain a bowel movement. The guidelines for perineal care in some nursing homes require at least 31 steps for the female and 30 steps for the male. The in-service training process for new employees requires several hours of training to become certified. Due to the undesirable nature of the perineal cleanup process and staffing shortages at many nursing homes, it is not uncommon for the cleanup process to be delayed or steps in the procedures be forgotten or ignored. That is, the bedridden person may remain soiled for an extended period increasing the likelihood of skin irritation issues. Accordingly, it is desirable to provide a solution that reduces the cleanup burden imposed by diapers while reducing or eliminating waste contact with the person.
Onset of Depression:
When people who have been ambulatory in everyday life and are suddenly are confronted with a stroke, accident injury or other experience find themselves bedridden on their back it causes a reality shock to them. The management of urine and bowel function creates an physical challenge that predictably and quickly impacts the emotional and mental state of the bedridden.
Medications and Complications for the Bedridden:
Odor containment, embarrassment, withdrawal, and avoidance of visitors is frequently a side effect of wearing diapers; beginning a downward morale spiral leading to depression. Depression is treatable with medicines however; complications of constipation and further physical change in bowel function create a cascade of issues that also need to be managed with medication.
Anticolonergic medications induce constipation that then require stool softeners or laxative be prescribed to induce bowel movements. These same medications alter other body functions. For example, pupil dilation of the eyes and blurred vision resulting in paralysis of ocular accommodation is a common side effect of anticolonergic medications. The inability of the bedridden to read and see, as they are accustomed, contributes significantly to depression.
Diarrhea is a frequent concomitant of this combination of medication and methods to deal with the function of the bowel. The desired balance of bowel function that is normal in healthy individuals is now in a state of induced unpredictable balance; making it difficult for caregivers to establish a care routine for the bedfast. Effectively this medicated state of imbalance has introduced the first stage of concern for continence and or incontinence care.
Stages of Incontinence:
Incontinence, natural or medically induced, pose a series of challenges for caregivers. Bedridden persons span a wide spectrum from alert and cooperative to completely unaware. The progressive stages of incontinence from least to most severe are:                Mental and physical ability to cooperate fully with caregivers. The person is confined to bed for bowel and urine functions but can recognize urges.        Mental and physical ability to cooperate with timing to perform the bowel function on a known schedule.        Mentally capable to cooperate; but unable to have physical control or awareness when bowel function may occur.        Mentally and physically unable to coordinate bowel function on any timing schedule.        Totally unable to assist the care giver in any way when bowel function occurs.        Physically rolling and changing positions frequently without regard to any ongoing bowel function.        Near death with dehydration when bowel function ceased to occur or present caregiver problems.        